Basic Information
| Provider Information | |||||||||
| NPI: | 1831574326 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | WYREBEK | ||||||||
| FirstName: | RITA | ||||||||
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| Credential: | MD MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1465 S GRAND BLVD | ||||||||
| Address2: | DIVISION OF NEONATOLOGY | ||||||||
| City: | ST. LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145775642 | ||||||||
| FaxNumber: | 3142686410 | ||||||||
| Practice Location | |||||||||
| Address1: | 1465 S GRAND BLVD | ||||||||
| Address2: | DIVISION OF NEONATOLOGY | ||||||||
| City: | ST. LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145775642 | ||||||||
| FaxNumber: | 3142686410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2015 | ||||||||
| LastUpdateDate: | 04/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | 2022005755 | MO | N | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | 2080N0001X | ME140705 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
No ID Information.